HomeMy WebLinkAboutPermit Plumbing 1996-04-16SPRINGFIELO
BACKFLOU PREVENTION DEVICE PERHIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SATETY.DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
JOB LOCATION:
.. ASSESSORS HAP *:
OFFICE:
INSPECTION LINE:
726-3759
726-3769
€-
TAX LOT {: E
OUNER:5-Ort_/)E/:a E
ADDRESS:PHONE *:2 r.7 -//2o
CITY:STATE c ZIIz
BACKFLoUPEBuITIS$15.00+$.75(STATESI,RCHARGE)+$.45(ADUIN.FEE)
C.-)
e-l QCONTR/ICTOR:
ADDRESS:PHONE *:
STATE:ZTP
*rr7 )s 2 DXPIRBS:
FOR OFFICE USB
- '- //4o
f'r\)CITY:u7ruCONSTRUCTION CONTRACTORS REGISTRATION
BY SIGNING THIS PERMIT/APPLICATION, I AGREB TO CALL FOR AN INSPECTION ONCE TTIE
BAcKFLou pREvBNTToN DEvrcE HAs BEEIit TNSTALLBD AND rs vrsrBLE FOR rNSPEcrrON
<iiE-IIOg>. T ELSO STATE TTIAT ALL INTIORMATION ON THIS PERHIT/APPLICATION IS
CORRECT.
$16.20
DATE OT APPLICATION:
RECEIPT *:ISSUED BY:
2aTOTAL AMOUNT COLLECTED:
JOB II:?a-=-=
aC'TY
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